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Utah State Board of Education

Parent/Guardian Consent Form


Human Sexuality Instruction

Parents must receive this form no later than two weeks prior to the beginning of instruction

Name of Student:
Course: Teacher(s):
School: Telephone Number:

Dear Parents/Guardian:

As part of your childs education, he/she has enrolled in a course that includes instruction on topics related to
human sexuality. You are receiving this consent form because instruction and/or discussion of human sexuality
topics are controlled by state law and/or Utah State Board of Education rule. Please read the form carefully,
select one option, sign, and return to the teacher above. Your student will not be allowed to participate in
class activities without this completed and signed form on file. Thank you.

Information
All instruction related to human sexuality and/or sexual activity will take place within the context of Utah State
Law (53A-13-101) and Utah State Board of Education rule (R277-474) as follow:
The public schools will teach sexual abstinence before marriage and fidelity after marriage
There will be prior parental consent before teaching any aspect of contraception and/or condoms
Students will learn about communicable diseases, including those transmitted sexually, and HIV/AIDS
Program materials and guest speakers supporting instruction on these topics have been reviewed and
approved by the local district review committee.
The following are NOT approved by the State Board of Education for instruction and may not be taught:
The intricacies of intercourse, sexual stimulation, or erotic behavior;
The advocacy of premarital or extramarital sexual activity;
The advocacy or encouragement of the use of contraceptive methods or devices;
The advocacy of sexual activity outside of marriage.

In accordance with Utah State Board of Education Rule R277-474-7-D, teachers may respond to spontaneous
student questions for the purpose of providing accurate data or correcting inaccurate or misleading
information or comments made by students in class regarding human sexuality.
The curriculum for this course includes instructions and/or discussions about the topics checked below
For Teacher Use Only
reproductive anatomy and health contraception, including condoms
human reproduction HIV and AIDS (including modes of transmission
information on self-exams sexually transmitted diseases (terms of a
date rape sensitive/explicit nature may be defined)
Factual, unbiased information about contraception and condoms may be presented as part of this course (only
if the box above is checked). Demonstrations on how to use condoms or any contraceptive means, methods,
or devices are prohibited and are NOT authorized.

Name of Student:
Options: Please read and check only one of the following:
Option 1
I grant permission for my child to participate in the scheduled activities/discussions as described above
Option 2
I grant permission for my child to participate in the scheduled activities/discussions as described above,
with the exception of . I understand that my child will receive an
alternative assignment of equal value and will not attend the regularly scheduled class on the day of this
instruction.
My child will be provided a safe, supervised place within the school during this class period(s). It will be
his/her responsibility to report to the pre-arranged location, check in with the teacher or supervisor, and
submit the completed assignment to the appropriate person.
Option 3
Prior to making a decision, I will contact you at the school within the next two weeks to arrange a time to
discuss the planned curriculum and/or review the materials
Option 4
I DENY permission for my child to participate in any of the scheduled activities/discussions as checked in
the above box.
I understand that while my child is not involved in the exempted portion of the curriculum, he/she will be
provided a safe, supervised place within the school during the class period(s), and will received an
alternative assignment related to other elements of the course.

This consent form may be sent to parents within two weeks after the beginning of the course, but not less than
two weeks prior to instruction of the identified topics. Under state law, your child cannot participate in the
scheduled instructional activity specified above unless and until this signed letter of permission is returned to
the teacher identified on this form. Signed forms will be kept on file at the school for a minimum of one year.

Please sign and return

I have read this form and have chosen one option from the preceding list

Parent/Guardian Signature:

Telephone Number: Date:

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